Do I need a rabies vaccination?

Some of countries most popular with British holidaymakers carry the highest risk of contracting rabies, Public Health England (PHE) has warned after the death of a UK traveller in Morocco.
Egypt, Turkey and Tunisia are among the destinations that the Government has ascribed a “high risk” ranking and said that all visitors to rabies-affected countries “should avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for rabies vaccine prior to travel”. Bali, Mexico and South Africa, too, are rated “high risk”.
PHE issued its guidance in the wake of the death of an unnamed Briton who had contracted the disease after being bitten by a cat.
Dr Mary Ramsay, head of immunisations at PHE, said: “This is an important reminder of the precautions people should take when travelling to countries where rabies is present. If you are bitten, scratched or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay.”
What is rabies?
Rabies is “an infectious viral disease that is almost always fatal following the onset of clinical symptoms”, according to the World Health Organisation (WHO).
The disease is transferred from animals to humans through bites, licks and scratches and usually via saliva.
Initial symptoms can include anxiety, headaches and fever, says PHE. As the disease progresses, there may be hallucinations and respiratory failure. Spasms of the muscles used for swallowing make it difficult for the patient to drink. The incubation period between being infected and showing symptoms is between three and 12 weeks, depending on the site of the initial infection. Once symptoms have developed, rabies is almost always fatal.
More than 59,000 die from the disease every year, with dogs contributing up to 99 per cent of all transmissions to humans, the WHO says.
It is thought that more than 15 million people a year receive a post-bite vaccination that prevents hundreds of thousands of deaths.

Where is rabies found?
Rabies is most common in Asia and Africa but there are a number of European nations said to be “high risk”, such as Poland and Belarus. The WHO says that the disease is present on all continents except Antarctica, but that 95 per cent of the human deaths take place in Asia or Africa.
The UK has been rabies-free since the beginning of the 20th century, though a rabies-like virus still resides in some wild bats. According to the Government, the last recorded case of rabies in the UK was in 2012, when a British grandmother was bitten by her son’s pet dog in India.
Sharanjit Ubhi, 58, developed symptoms three months after her trip having returned home to Dartford in Kent. Her family told the coroner the bite was so small the grandmother did not even think to get herself checked by a doctor at the time.
PHE ascribes three different levels of risk to the world’s territories – no risk, low risk and high risk. Some eastern European countries such as Slovenia, Croatia and Bulgaria are given a “low-risk” rating but the advice adds that “foxes are high risk”.
The same is true of the US and Canada, where the warning is “low risk but foxes, skunks and racoons are high risk”.

What should I do if travelling to an area with rabies?
Dr Richard Dawood, Telegraph Travel’s health expert, says it is not always possible to eliminate the chance of an unwanted encounter with a street dog.
“Having been attacked by a dog on my own travels, I have been a lifelong fan of pre-travel rabies vaccination: it is safe, effective, greatly simplifies treatment following a bite, and can be done cheaply,” he said.
“Vaccination requires three injections, ideally with a seven-day gap between the first two, and 14 to 21 days between the next. Protection is usually long-lasting. Most people have a full dose of vaccine, injected deep into a muscle. However, a reduced dose is also highly effective, given ‘intradermally’ into the top layer of the skin, enabling more than one person to be vaccinated from a single vial.
“The Department of Health’s official Green Book says that ‘suitably qualified and experienced health care professionals’ may use this method, but does not recommend it, mainly because it requires skill to administer it correctly.
“However, it is approved by the World Health Organisation, used in other countries, supported by key British experts and should be used more widely. The intradermal method conserves supplies of this scarce vaccine, and cuts the cost of a typical three-dose course from about £180 to about £75 (plus any appointment costs).”

What should I do if bitten?
Scrub and rinse the wound thoroughly, and disinfect with alcohol or strong antiseptic. Get prompt local advice. Back this up with a call to your travel insurance company, your GP, or a specialist travel clinic. Always seek reliable help.
Without previous vaccination, you need a rapid vaccine course, plus an injection of rabies immune globulin (RIG) to give protection until the vaccine takes effect. RIG is scarce and very expensive, and reliable treatment can be hard to find. If you have previously been vaccinated against rabies, simple booster doses after a bite give full protection.